The case for simulation

Prior to starting their clinical rotations, Michener’s medical laboratory science students spend 10 weeks in a simulated clinical environment as part of their summer semester. They perform tasks as they would in a real lab – everything from the tests and procedures they spent the previous two years learning, to having what one recent graduate describes as “awkward phone calls with angry doctors.”

Simulation activity is embedded into the program curriculum from very early on, designed developmentally as knowledge and skill level progress. The 10-week immersive simulation experience allows Michener students to learn in a highly realistic environment providing an opportunity to practice and synthesize everything they have learned before heading to hospitals and labs for their clinical placements.

“The simulation environment replicates the actual rotations and discipline specific benches students will experience over the course of their clinical year,” says Sydney Redpath, Senior Director of Academic Planning and Operations at The Michener Institute.

Ms. Redpath was part of a group from Michener who attended a Canadian Society for Medical Laboratory Science (CSMLS) forum on April 23 to discuss the possibilities of how simulation can complement clinical education in the field of medical laboratory sciences.

The forum came on the heels of a landmark study from the National Council of State Boards of Nursing (NCSBN) in the United States that suggests simulation is a more effective training tool for health care providers than previously considered.

This research study showed that simulation was able to replace as much as half of the clinical experience, with virtually no difference in the levels of clinical competency as evaluated by instructors and knowledge assessments. The knowledge and skill nurses get from training in more heavily clinical-based environments versus simulation-based environments was almost identical. This alone is significant because it shows that simulated clinical experiences may be just as effective as clinical placements in training health care providers how to perform procedures and how to work in the clinical environment.

Bridging the gap

“Simulation allows for immersion into the scope of practice,” said Dr. Pam Jeffries, one of the lead authors of the NCSBN study and a keynote speaker at the CSMLS forum.

Citing the results of the research, she indicated that part of the value of simulation lies in providing hands-on training in the event of shortages or bottlenecks in clinical placements.

“Simulation has proven its worth over the past few decades in medical and nursing education and is increasingly being considered across all health professions as a way of advancing a number of goals,” adds Dr. Brian Hodges, Executive Vice-President of Education at University Health Network (UHN), who joined Dr. Jeffries as keynote speaker at the forum.

“These include bridging the gap between the classroom and the clinic, allowing greater practice of skills in simulation before they are tried on real patients, supplementing education models in a way that helps with the clinical placement bottleneck and building innovative models of assessment of competence for practice.”

For a field that is facing personnel shortages due in part to clinical training challenges, embracing simulation to train more new medical laboratory technologists (MLTs) is a potential game changer. For the national certifying body for MLTs and medical laboratory assistants, simulation may be an opportunity to address specific training needs and staffing shortages.

“We’re looking at simulation as a way to graduate and train more MLTs,” says Christine Nielsen, CEO of CSMLS.

“Simulation could be the key to increasing the capacity of our existing educational programs, which is critical to addressing the health human resource needs across the country.”

Guided by the hypothesis presented in the NCSBN study, encouraging more education institutions to adopt simulation into their curricula may help to supplement clinical education, which would allow schools to train and graduate more students in the medical laboratory sciences field.

Michener’s own simulation-heavy curriculum is a step towards ensuring graduate preparedness from the first day they enter clinical placement.

“When Michener implemented 10 weeks of simulated clinical practice, it took a leap of faith and reduced clinical time by close to 50%. Fortunately, there was no measurable difference in student quality after this change, as described by clinical educators in an evaluation of the new education model,” says Ms. Redpath.

“Students were able to attain entry to practice competency levels in the shorter period of time, and there was also no change in success rates on certification exams.”

The “hidden curriculum”

Within the field of medical laboratory sciences, where medical laboratory technologists aren’t necessarily interacting directly with patients in the same way as other health care professions, simulation is key to teaching a so-called “hidden curriculum” that teaches non-technical, but essential, skills like conflict resolution, appropriate communication, managing workplace tensions interruptions, and safety issues.

As Dr. Hodges added in his keynote talk at the forum, the hidden curriculum is critical for transferring simulation to real situations, “going from highly-structured simulation scenarios into an unstructured world.”

“Michener has a long history of innovation and excellent in simulation and will continue to be a leader in Canada as this field moves forward,” said Dr. Hodges.